Prosthetics and Orthotics International最新文献

Uneven pressure distribution within a transtibial prosthetic socket can lead to discomfort, skin degradation, and suspended prosthesis use. Current custom interfaces to improve pressure distribution are often costly, time-intensive to fabricate, or cannot be incorporated into standard socket fabrication methods. In this technical note, we describe the design and preliminary clinical evaluation of a novel transtibial prosthetic socket insert with modifiable mechanical properties, which can be incorporated into the current clinical cycle of care. The custom insert (termed "inlay") relies on a triangular unit cell, which can be modified based on the desired stiffness profile. Inserts are 3D printed in a soft polymer material and inset into shape-matched voids in a socket creating regions of custom offloading. Preliminary clinical efficacy of the inserts was assessed in a pilot long-term cross-over evaluation. After Institutional Review Board approval, 3 pilot participants wore a shape-matched replica of their habitual socket modified for insert use and a shape-matched socket without. Sockets were worn for 4-week each, and inner socket pressures were measured with thin film pressure sensors at the end of the wear period. Peak pressures within the distal tibial region of interest were decreased for 2 of 3 participants during midstance of level-ground walking when wearing the socket with inlays. The technical methods and results presented provide a new method to address high pressure regions within a transtibial prosthetic socket. The 3D-printed inlays can be rapidly produced allowing for easy modification and replacement without require new socket fabrication.

Background: The clinical landscape of limb loss rehabilitation across Canada is poorly delineated, lacks standard rehabilitation guidelines, and is without a shared clinical database.

Objective: To address these gaps, the objective of the present study was to undertake an environmental scan of the rehabilitation centers across Canada that provide inpatient and/or outpatient services to the limb loss community.

Study design: An environmental scan was conducted to describe the rehabilitation service structure, program services, and outcome measures of sites across Canada.

Methods: A survey was sent to 36 rehabilitation centers providing care to people with amputations.

Results: Of the 36 centers, 31 completed the survey (11 = Ontario; 8 = Quebec; 6 = British Columbia; 2 = Saskatchewan; 2 = New Brunswick; 1 = Alberta; 1 = Manitoba). Twenty-five provided both inpatient and outpatient services, 1 provided inpatient care only, and 5 provided only outpatient services. Interprofessional services were provided to a wide range of upper extremity amputation and lower extremity amputation patient populations. Range of motion was the most commonly collected outcome for both patients with upper extremity amputation and lower extremity amputation. With regard to prosthetics and orthotics fabrication, 9 of the sites had these services on-site while 15 had off-site fabricators, 6 had both, and 1 provided no response.

Conclusions: Our findings highlight that limb loss rehabilitation and prosthetic care delivery is variable across Canada with respect to clinical team members, locations of services, and complementary services such as mental health treatments and peer support groups.

Limited data are available related to using a low-cost prosthetic knee while walking. To address this gap, this study compared the performance of a low-cost prosthetic knee with 2 more advanced prosthetic knees while walking on even and uneven terrains. Two adult subjects with above-knee amputations completed walking trials using a low-cost prosthetic knee (ReMotion knee) and their personal prosthetic knees (Ottobock 3R60 Pro mechanical knee and Ossur Rheo microprocessor knee) over even and uneven terrains. Several measures of gait performance were obtained including step size, stability, energy expenditure, as well as user perception of ReMotion workload and performance during gait. Effects of the ReMotion knee were different between the mechanical and microprocessor knee user. In addition, subjects perceived the positive aspects associated with the ReMotion knee to be its lightweight feature and their perceived increased in stability during walking while both subjects disliked the inability of the ReMotion knee to adjust to preferred walking speeds. This study provided an understanding of low-cost prosthetic technology among lower-limb amputees compared to prosthetic technology with more technologically advanced assistance. These findings may help guide future low-cost prosthetic knee design considerations for use on various terrains.

Background: Cranial remolding orthoses are an effective treatment of deformational plagiocephaly. Typical treatment durations are well documented. However, treatment duration can be affected by multiple factors and may not be a true representation of the time necessary to achieve a successful clinical outcome.

Objective: This study compared the time to achieve a successful clinical outcome against the total treatment duration for cranial remolding orthosis therapy in infants with deformational plagiocephaly.

Study design: This is a retrospective study of infants treated for deformational plagiocephaly with a cranial remolding orthosis.

Methods:  A total of 300 infants with deformational plagiocephaly who were treated with a cranial remolding orthosis were grouped by corrected age at initiation of treatment and by severity of deformity. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. For the 226 infants who achieved a successful outcome, time to successful outcome and treatment duration were compared between the groups.

Results: The time to successful outcome depended on severity but not on age at initiation. The median time to successful outcome ranged from 6 weeks to 17.5 weeks, depending on the severity of the deformity. Time to successful outcome was significantly shorter than treatment duration for infants with an initial cranial vault asymmetry of less than 17 mm.

Conclusion: Current treatment durations for infants with moderate plagiocephaly may be longer than necessary. Estimated treatment time lines should be based on the initial severity of the infant's deformity.

Introduction: Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking.

Methods:  A blinded, randomized control trial was conducted in a group of K3-K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances (p < 0.05) and Cohen d.

Results: Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m2) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force (p = 0.02) and external knee adduction moment (p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side (p < 0.01).

Conclusion: Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals' ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.

Objectives: To explore the impact of an aesthetic prosthetic leg cover on attitudes toward individuals with lower-limb amputation and associated social interaction cues among the general UK population.

Study design: Two novel experimental methodologies.

Methods: In study 1, participants (n = 188) viewed 1 of 3 images of an individual: (1) wearing a traditional stem prosthetic, (2) wearing an aesthetic leg cover, or (3) as a nonamputee. They then completed an attitude scale and rated the personality of the individual using the 10-item Big Five Inventory. Study 2 (n = 31) used eye tracking and facial expression software to explore gaze and facial arousal when viewing 1 of 9 manipulated videos of the same individual talking about 3 different scenarios.

Results: In study 1, the aesthetic leg cover led to significantly higher ratings of agreeableness than stem and nonamputee images and significantly higher ratings of extraversion than the nonamputee image. Attitudes toward an individual with a prosthesis did not significantly differ depending on which image they viewed and were generally positive. In study 2, all participants focused mainly on the individual's face regardless of scenario topic or leg condition, although participants focused more around the leg cover in more active contexts.

Conclusions: Customized aesthetic leg covers may help individuals living with amputation to be perceived more positively in social situations. These experimental methodologies could be extended to explore the differential impact of context, functionality, and activity of specific types of customized aesthetic prosthetics and could help inform shared decision-making processes in clinical settings.

Testing is one of the most significant phases of any engineering process, the last process followed by conceptualization, designing, and fabricating. If the testing outcomes are not genealogy sensible measurables, then eventually it calls for a redesign overhaul. Existing testing equipment to analyze the load and failures are conventional digital universal testing machines with minimum jigs and fixtures. In addition, the existing fixtures cannot be adapted to the anatomy of a human finger. Consequently, the present work explores the best possible design of a jig for testing the naturally articulated movement of a human finger (prosthetic wear-on). Furthermore, the present jig design checks a wide range of parameters such as freedom of motion, a path along with curvature, load, failures, and intermittent positions of applied load, which is adaptable to existing universal testing machines available for broader applications.

Background: Customized foot orthoses are used to treat flexible flatfoot regarding medial longitudinal arch (MLA) support, alignment correction, and pain management. Recently, 3-dimensional (3D) printing orthosis has become the focus of discussion regarding function and manufacturing. We aimed to investigate differences in biomechanical effects between flat insole (Flat), conventional foot orthosis (Cinsole), and 3D printed foot orthosis (3Dinsole) use on MLA support and rearfoot alignment during walking in adult flexible flatfeet.

Methods: Twelve men with flexible flatfoot were recruited. Data were collected and analyzed using a Vicon motion capture system under 3 trial conditions: Flat and >1 month after using Cinsole and 3Dinsole. Repeated-measures analysis of variance with Bonferroni post hoc tests was used to compare kinematics variables, foot pain, and satisfaction.

Result: Dynamic navicular drop significantly reduced with the use of the Cinsole and 3Dinsole compared with Flat ( P < 0.001; ηp 2 = 0.65). The maximum rearfoot eversion angle with the use of the Cinsole and 3Dinsole significantly reduced from Flat ( P < 0.001; ηp 2 = 0.56). Foot pain score significantly decreased after using foot orthoses; satisfaction between Cinsole and 3Dinsole was not significantly different.

Conclusions: Thus, Cinsole and 3Dinsole are effective alternative treatments of MLA support and rearfoot alignment in adults with flexible flatfoot. 3D printing is a future technology with potential to replace conventional production methods. However, material characteristics, design, and manufacturing process can affect treatment outcomes; hence, our results may not represent all variations of 3D printed foot orthoses.